Congress Still Rejecting TRICARE Fee Increases
6/25/08 - The House passed its version of the 2009 National Defense Authorization Act (NDAA, HR 5658) in May, rejecting the Pentagon and DoD Task Force plan to steeply raise TRICARE fees and co-pays, agreeing with May ’s Senate Armed Services Com-mittee mark-up. The Senate Armed Services Committee mark-up includes $26.1 billion for the Defense Health Program, which includes the $1.2 billion necessary to cover the rejection of DoD Task Force proposals to raise TRICARE fees, add new enrollment fees, and increase pharmacy co-payments (see more below). The full Senate is expected to take up this issue soon, and a few hurdles remain to complete action on the final 2009 NDAA, but at this point indications look good for military retiree health care. While NAUS anticipates no change in this issue as the NDAA moves to final decision, we encourage our members to continue to let your elected officials know you expect them to continue to reject TRICARE cost increases.

Medical School Training with Live Animals Criticized
7/2/08 - The Uniformed Services University of the Health Sciences (USUHS) is being criticized for using live animals in some medical procedures. USUHS students and faculty insert breathing tubes in live ferrets to practice intubation of human infants, and they perform surgeries on live pigs, according to a petition delivered by the Physicians Committee for Responsible Medicine to the Department of Defense. The petition suggests the university use alternatives to live animals, such as high-tech human simulators, and points out that only 8 of the nation's 154 medical schools still use live animals. The federal Animal Welfare Act requires that schools assess alternatives to live animals but does not prohibit their use, and USUHS had previously determined that the use of animals is an important part of the curriculum. RADM Marion Balsam, USN (Ret), a former USUHS professor and currently a researcher at the National Institutes of Health, was one of the signers of the petition, calling the practice “an abomination.” 

DoD Task Force on the Future of Mil. Health Care
The DoD Task Force on the Future of Military Health Care’s final report calls for a TRICARE For Life enrollment fee of $120 per year per person. If adopted, this will affect 1.9 million military beneficiaries over the age of 65, and would be in addition to the MediCare Part B premiums that TRICARE For Life beneficiaries already pay. Task Force co-chair Dr. Gail R. Wilensky, said the TRICARE For Life enrollment fee’s purpose is not to save program costs but to be consistent with the Task Force's philosophy that military health care for retirees should be "very generous, but not free."

The Task Force’s report (available online here) also repeats calls for higher TRICARE fees, deductibles and co-payments for under-65 military retirees and their families – nearly 3 million people. Citing the fact that no changes in TRICARE fees, deductibles and co-payment percentages have occurred since the mid-1990s, along with affirming the desire to avoid any changes to the health care benefits for active duty personnel, the task force said the relative cost share paid by retirees back then should be restored by raising fees now. The Task Force recommends phasing in this "catch up" in TRICARE fee increases over four years. The report's rec-ommendation would raise the average enrollment fee paid for an under-65 retiree family enrolled in TRICARE Prime from the current level of $460 per year to $1,100 per year (or from about $40 a month now to $90 a month). Other recommend-ations:

• Increase deductibles for TRICARE Standard from $300 a year for families and $150 for individuals to $600 and $300 respectively. 
• TRICARE fees and deductibles would be indexed and automatically adjusted upwards each year to keep pace with rising healthcare costs.
• Establishment of tiers for TRICARE fees, based on grade/rank at retirement, so retirees with higher retirement pay would pay higher fees.
• A downward adjustment to the TRICARE catastrophic cap for retirees (to $2,500 from the current $3,000).
• A TRICARE Standard enrollment fee of $120 (families) and $60 (ind.) annually.
• Increases in TRICARE retail pharmacy copayments (now $3 to $22) to a range of $15 to $45.
• Restrictions on ability to change programs (e.g., shift from TRICARE Standard to Prime, etc.) by establishing an annual "open season" period.

TRICARE Adds Coverage for MRI Screenings for Breast Cancer
10/07 - Coverage for Magnetic Resonance Imaging (MRI) screening for women at high risk of developing breast cancer is now provided under TRICARE. Doctors should use the American Cancer Society’s guidelines regarding risk to determine who qualifies for the TRICARE-covered MRI. “An MRI is a clearly superior tool for screening the highest risk women for breast cancer,” said MG Elder Granger, USA, Deputy Director, TRICARE Management Activity. Breast cancer is the third most common cancer among TRICARE beneficiaries.

Low-cost Generic Drug Programs
Wal-Mart and Target sell many generic drugs for $4 per prescription. The $4 price is for a 30-day supply, and insured customers are allowed to pay the $4 per prescription price even if that is less than the co-payment required by their plan. Review the $4 drug lists of Wal-Mart and Target.

Congress Drops Ball on MEDICARE Physician Rate Cut
6/26/08 - The Senate failed to clear a 60-vote threshold to consider legislation to postpone the July 1st 10.6% cut in Medicare reimbursement payments to doctors and hospitals through the end of 2009, which passed the House on 6/24 with a 355-59 vote. More.

TRICARE Standard Accepted by More Doctors
4/08 – More civilian healthcare providers are accepting new TRICARE patients, according to a recent (2007) survey. The DoD Survey of Civilian Physician Acceptance of TRICARE Standard shows that 84% of physicians in the 53 different hospital service areas surveyed do accept new TRICARE Standard patients. “It shows that more doctors are working with us to ensure that our reserve component warriors, retirees and their families have access to quality care,” said Army MG Elder Granger, deputy director of the TRICARE Management Activity (and NAUS Member). He added that in some locations, access to TRICARE Standard providers remains a concern, despite strong outreach efforts by TRICARE officials and expanding networks of providers. States that still show a need to increase acceptance include Alaska, Maryland, Colorado, Hawaii, Oklahoma, New York, New Jersey and Texas. The main reason cited for not accepting TRICARE Standard is the reimbursement rates for healthcare services.

Military Health System Blog
Read the latest right here! Assistant Secretary of Defense for Health Affairs, Dr. S. Ward Casscells, guest speaker at the 2007 NAUS Annual Meeting and a NAUS member, encourages members to stay up-to-date on military health system issues through this innovative blog. Access it here: http://mhs.osd.mil/mhsblog.jsp

GAO Military Health Care Report
6/07 - The Government Accountability Office (GAO) released its report to Congress on Military Health Care. The report, required by the 2007 National Defense Authorization act (NDAA) to evaluate factors identified by the Defense Department as contributing to increased TRICARE expenditures and the likelihood of achieving savings through DoD’s proposed fee and co-payment increases, is available online here.

DoD attributed its increased health care spending ($17.4 billion in 2000 to $35.4 billion in 2005) to inflation, required benefit enhancements, and an increased number of eligible beneficiaries choosing TRICARE. GAO found:

• Health care cost inflation was not based on DoD’s actual spending trends.
• DoD used incomplete information about TRICARE programs in developing the anticipated cost estimates.
• DoD lacked documentation on how the health care cost associated with the Global War on Terror was calculated.
• Increased spending per TRICARE beneficiary from 2001 to 2005 for active duty was 7.3%; for active duty family members, 8.6%; and for retirees and dependents under age 65, 7.2%. Separate analysis showed an increase of 16.2% in TRICARE for Life spending from 2003 to 2006.

GAO also found that DoD was unlikely to achieve its expected $9.8 billion savings over five years through increased TRICARE fees and deductibles for retirees and dependents under the age of 65. DoD based this estimate largely on a reduction of 500,000 beneficiaries under age 65 who would chose to leave or not enroll in TRICARE. According to the GAO, there are many reasons for DoD’s savings miscalculation:

• Projected number of TRICARE beneficiaries who would drop out or not enroll was too high.
• Estimated savings were too high because older and sicker beneficiaries who remain in TRICARE would incur greater-than-average medical expenses.
• Proposed savings, without the loss of TRICARE beneficiaries, would equal only $2.5 billion over 5 years, not $9.8 billion.
• DoD’s forecasting was hampered by uncollected and compiled data, such as the cost of other health insurance options and beneficiaries’ access to them.

The report also found that DoD’s $1.5 billion expected savings through increased retail pharmacy co-payments for all beneficiaries except active duty service members was unlikely.

Medicare Part D - Prescription Drug Coverage
If you are a military retiree and enrolled in Medicare Part B, you do not need to enroll in a Medicare Prescription Drug Plan - your TRICARE For Life pharmacy benefits are better than Part D plans.

If you are over 65 and enrolled in Medicare Part B, but are NOT a military retiree and are not eligible for medical care through the VA, you may want to consider Medicare Part D coverage.

TRICARE For Life Reminder
For those over 65 years of age and enrolled in Medicare Part B, you can visit any physician or other health care provider that accepts Medicare and TRICARE For Life (TFL). In most cases, the combination of the two will cover all medical expenses, with Medicare as the first payer and TFL as a “Supplement.”

Online Coordination of Benefits for Prescription Drugs
A new process to coordinate your TRICARE benefits with your other health insurance can now be completed electronically. That means you don't have to submit forms and wait for reimbursement for your out-of-pocket costs when getting your prescriptions filled at a TRICARE network retail pharmacy. Instead, your prescription drug transactions can be coordinated online by the retail pharmacy.